Practice Lesson of the week

Diabetic muscle infarction

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b2271 (Published 19 June 2009) Cite this as: BMJ 2009;338:b2271
  1. Malvinder S Parmar, associate professor, division of clinical sciences
  1. 1Northern Ontario School of Medicine, Laurentian and Lakehead Universities, Ontario, Canada
  1. Correspondence to: M S Parmar, Medical Office Building, Timmins and District Hospital, Suite E, 640 Ross Ave East, Timmins, ON, P4N 8P2, Canada atbeat{at}ntl.sympatico.ca
  • Accepted 15 September 2008

Timely diagnosis of diabetic muscle infarction helps prevent complications in a patient presenting with painful swollen extremity

Diabetic muscle infarction is a rare complication of diabetes that occurs in patients with type 1 diabetes (70% of total cases) or in patients with poorly controlled type 2 diabetes.1 It presents with sudden onset of a painful swelling, often of the thigh, which is bilateral in up to a third of patients, and it occurs spontaneously without a history of trauma or features of infection.2 Diabetic muscle infarction is under-recognised and often misdiagnosed,3 4 and treated as rhabdomyolysis or polymyositis. A high index of suspicion is needed to make a timely diagnosis and to avoid the use of steroids or surgical intervention. This report highlights the clinical investigations, laboratory tests, and imaging scans needed to establish the clinical diagnosis in a timely fashion to avoid unnecessary and possibly harmful interventions.

Case

A 38 year old man with a 10 year history of type 2 diabetes presented with severe pain and swelling of the thighs of two weeks’ duration. He described a burning pain mainly at the front of both thighs that started spontaneously and became bad enough to limit his mobility. He denied any injury or heavy exertion before the onset of symptoms. Nor had he been travelling or had a recent viral or febrile illness. He had used anti-inflammatory agents with some relief. He had no pain in other muscle groups or joints or symptoms of fever, chills, or night sweats. He had no history of skin rash, but he had a history of hypertension, stage 3 diabetic kidney disease, and diabetic retinopathy with previous photocoagulation …

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